8453-OL U.S. Individual Income Tax Declaration for an IRS e-file

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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM W-4, PAGE 1 of 2
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
PERFORATE: 179mm (67⁄8 ") FROM TOP TRIM

Date

Action

Purpose. Complete Form W-4 so that your
employer can withhold the correct federal income
tax from your pay. Because your tax situation may
change, you may want to refigure your withholding
each year.
Exemption from withholding. If you are exempt,
complete only lines 1, 2, 3, 4, and 7 and sign the
form to validate it. Your exemption for 2006
expires February 16, 2007. See Pub. 505, Tax
Withholding and Estimated Tax.
Note. You cannot claim exemption from withholding if (a) your income exceeds $850 and includes
more than $300 of unearned income (for example,
interest and dividends) and (b) another person can
claim you as a dependent on their tax return.
Basic instructions. If you are not exempt, complete
the Personal Allowances Worksheet below. The
worksheets on page 2 adjust your withholding
allowances based on itemized deductions, certain
credits, adjustments to income, or two-

earner/two-job situations. Complete all worksheets
that apply. However, you may claim fewer (or zero)
allowances.
Head of household. Generally, you may claim
head of household filing status on your tax return
only if you are unmarried and pay more than 50%
of the costs of keeping up a home for yourself and
your dependent(s) or other qualifying individuals.
See line E below.
Tax credits. You can take projected tax credits
into account in figuring your allowable number of
withholding allowances. Credits for child or dependent care expenses and the child tax credit may
be claimed using the Personal Allowances Worksheet below. See Pub. 919, How Do I Adjust My
Tax Withholding, for information on converting
your other credits into withholding allowances.
Nonwage income. If you have a large amount of
nonwage income, such as interest or dividends, consider making estimated tax payments using Form
1040-ES, Estimated Tax for Individuals. Otherwise,
you may owe additional tax.

Signature

O.K. to print

PRINTS: HEAD to HEAD
INK: BLACK

Revised proofs
requested

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form W-4 (2006)

Date

Two earners/two jobs. If you have a working
spouse or more than one job, figure the total number
of allowances you are entitled to claim on all jobs
using worksheets from only one Form W-4. Your
withholding usually will be most accurate when all
allowances are claimed on the Form W-4 for the
highest paying job and zero allowances are claimed
on the others.
Nonresident alien. If you are a nonresident alien,
see the Instructions for Form 8233 before completing this Form W-4.
Check your withholding. After your Form W-4
takes effect, use Pub. 919 to see how the dollar
amount you are having withheld compares to your
projected total tax for 2006. See Pub. 919, especially if your earnings exceed $130,000 (Single) or
$180,000 (Married).
Recent name change? If your name on line 1
differs from that shown on your social security
card, call 1-800-772-1213 to initiate a name change
and obtain a social security card showing your correct name.

Personal Allowances Worksheet (Keep for your records.)

A

Enter “1” for yourself if no one else can claim you as a dependent
● You are single and have only one job; or
B Enter “1” if:
● You are married, have only one job, and your spouse does not work; or
● Your wages from a second job or your spouse’s wages (or the total of both) are $1,000 or less.

兵

A

其

B

C Enter “1” for your spouse. But, you may choose to enter “-0-” if you are married and have either a working spouse or
C
more than one job. (Entering “-0-” may help you avoid having too little tax withheld.)
D
D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return
E
E Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above)
F
F Enter “1” if you have at least $1,500 of child or dependent care expenses for which you plan to claim a credit
(Note. Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)
G Child Tax Credit (including additional child tax credit):
● If your total income will be less than $55,000 ($82,000 if married), enter “2” for each eligible child.
● If your total income will be between $55,000 and $84,000 ($82,000 and $119,000 if married), enter “1” for each eligible
G
child plus “1” additional if you have four or more eligible children.
䊳
H Add lines A through G and enter total here. (Note. This may be different from the number of exemptions you claim on your tax return.)
H
● If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions
For accuracy,
and Adjustments Worksheet on page 2.
complete all
● If you have more than one job or are married and you and your spouse both work and the combined earnings from all jobs
worksheets
exceed $35,000 ($25,000 if married) see the Two-Earner/Two-Job Worksheet on page 2 to avoid having too little tax withheld.
that apply.
● If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.

兵

Cut here and give Form W-4 to your employer. Keep the top part for your records.
Form

W-4

Department of the Treasury
Internal Revenue Service

1

䊳

Whether you are entitled to claim a certain number of allowances or exemption from withholding is
subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.

Type or print your first name and middle initial.

Last name

Home address (number and street or rural route)

City or town, state, and ZIP code

5
6
7

OMB No. 1545-0074

Employee’s Withholding Allowance Certificate
2

2006

Your social security number

Married, but withhold at higher Single rate.
3
Single
Married
Note. If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.
4

If your last name differs from that shown on your social security
card, check here. You must call 1-800-772-1213 for a new card. 䊳

5
Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2)
6
Additional amount, if any, you want withheld from each paycheck
I claim exemption from withholding for 2006, and I certify that I meet both of the following conditions for exemption.
● Last year I had a right to a refund of all federal income tax withheld because I had no tax liability and
● This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.
䊳
If you meet both conditions, write “Exempt” here
7

$

Under penalties of perjury, I declare that I have examined this certificate and to the best of my knowledge and belief, it is true, correct, and complete.

Employee’s signature
(Form is not valid
unless you sign it.)
8

䊳

Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.)

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

Date
9

䊳

Office code
(optional)

Cat. No. 10220Q

10

Employer identification number (EIN)

Form

W-4

(2006)

2
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM W-4, PAGE 2 of 2
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES.
PRINTS: HEAD to HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
PERFORATE: See Page 1 Specifications
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form W-4 (2006)

Page

2

Deductions and Adjustments Worksheet
Note. Use this worksheet only if you plan to itemize deductions, claim certain credits, or claim adjustments to income on your 2006 tax return.
1 Enter an estimate of your 2006 itemized deductions. These include qualifying home mortgage interest,
charitable contributions, state and local taxes, medical expenses in excess of 7.5% of your income, and
miscellaneous deductions. (For 2006, you may have to reduce your itemized deductions if your income
1 $
is over $150,500 ($75,250 if married filing separately). See Worksheet 3 in Pub. 919 for details.)
$10,300 if married filing jointly or qualifying widow(er)
2 Enter:
$ 7,550 if head of household
2 $
$ 5,150 if single or married filing separately
3 Subtract line 2 from line 1. If line 2 is greater than line 1, enter “-0-”
3 $
4 Enter an estimate of your 2006 adjustments to income, including alimony, deductible IRA contributions, and student loan interest
4 $
5 Add lines 3 and 4 and enter the total. (Include any amount for credits from Worksheet 7 in Pub. 919)
5 $
6 Enter an estimate of your 2006 nonwage income (such as dividends or interest)
6 $
7 Subtract line 6 from line 5. Enter the result, but not less than “-0-”
7 $
8 Divide the amount on line 7 by $3,300 and enter the result here. Drop any fraction
8
9 Enter the number from the Personal Allowances Worksheet, line H, page 1
9
10 Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earner/Two-Job Worksheet, also
enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1
10

兵

其

Two-Earner/Two-Job Worksheet (See Two earners/two jobs on page 1.)
Note. Use this worksheet only if the instructions under line H on page 1 direct you here.
1 Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet)
2 Find the number in Table 1 below that applies to the LOWEST paying job and enter it here

1
2

3

If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter
“-0-”) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet
3
Note. If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4–9 below to calculate the additional
withholding amount necessary to avoid a year-end tax bill.
4
5
6
7
8
9

Enter the number from line 2 of this worksheet
4
Enter the number from line 1 of this worksheet
5
Subtract line 5 from line 4
Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here
Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed
Divide line 8 by the number of pay periods remaining in 2006. For example, divide by 26 if you are paid
every two weeks and you complete this form in December 2005. Enter the result here and on Form W-4,
line 6, page 1. This is the additional amount to be withheld from each paycheck

6
7
8

$
$

9

$

Table 1: Two-Earner/Two-Job Worksheet
Married Filing Jointly
If wages from HIGHEST
paying job are—
$0 - $42,000

$42,001 and over

AND, wages from LOWEST
paying job are—
$0 - $4,500
4,501 9,000
9,001 - 18,000
18,001 and over
$0
4,501
9,001
18,001
22,001
26,001

-

All Others

Enter on
If wages from HIGHEST
line 2 above paying job are—
$42,001 and over
0
1
2
3

$4,500
9,000
18,000
22,000
26,000
32,000

0
1
2
3
4
5

AND, wages from LOWEST
paying job are—
32,001 - 38,000
38,001 - 46,000
46,001 - 55,000
55,001 - 60,000
60,001 - 65,000
65,001 - 75,000
75,001 - 95,000
95,001 - 105,000
105,001 - 120,000
120,001 and over

Enter on
line 2 above
6
7
8
9
10
11
12
13
14
15

If wages from LOWEST
paying job are—
$0 - $6,000
6,001 - 12,000
12,001 - 19,000
19,001 - 26,000
26,001 - 35,000
35,001 - 50,000
50,001 - 65,000
65,001 - 80,000
80,001 - 90,000
90,001 - 120,000
120,001 and over

Enter on
line 2 above
0
1
2
3
4
5
6
7
8
9
10

Table 2: Two-Earner/Two-Job Worksheet
Married Filing Jointly
If wages from HIGHEST
paying job are—
$0 - $60,000
60,001 - 115,000
115,001 - 165,000
165,001 - 290,000
290,001 and over

All Others
Enter on
line 7 above
$500
830
920
1,090
1,160

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this
form to carry out the Internal Revenue laws of the United States. The Internal Revenue
Code requires this information under sections 3402(f)(2)(A) and 6109 and their
regulations. Failure to provide a properly completed form will result in your being treated
as a single person who claims no withholding allowances; providing fraudulent
information may also subject you to penalties. Routine uses of this information include
giving it to the Department of Justice for civil and criminal litigation, to cities, states, and
the District of Columbia for use in administering their tax laws, and using it in the
National Directory of New Hires. We may also disclose this information to other countries
under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws,
or to federal law enforcement and intelligence agencies to combat terrorism.
You are not required to provide the information requested on a form that is subject to

If wages from HIGHEST
paying job are—
$0 - $30,000
30,001 - 75,000
75,001 - 145,000
145,001 - 330,000
330,001 and over

Enter on
line 7 above
$500
830
920
1,090
1,160

the Paperwork Reduction Act unless the form displays a valid OMB control number. Books
or records relating to a form or its instructions must be retained as long as their contents
may become material in the administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by Code section 6103.

The average time and expenses required to complete and file this form will vary
depending on individual circumstances. For estimated averages, see the instructions
for your income tax return.
If you have suggestions for making this form simpler, we would be happy to hear
from you. See the instructions for your income tax return.